Medicare Advantage vs Medigap

Be entitled to Medicare Part A and/or enrolled in Medicare Part B — Part D eligibility requires the beneficiary to be entitled to Part A and/or enrolled in Part B. A person entitled to Part A can join a standalone prescription drug plan (PDP), and so can a person enrolled in Part B. Part D does not require a Medigap policy, and it is not limited to those in Medicare Advantage — indeed, Medicare Advantage plans with drug coverage (MAPDs) are themselves one delivery form of Part D. Understanding who may enroll is the threshold question in every Part D sale.

National insurance concept

HMO, PPO, Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs) — Medicare Advantage (Part C) plans come in several managed care forms, including HMOs, PPOs, Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Each type organizes provider access and cost-sharing differently, but all must provide the benefits covered under Original Medicare. Medigap policies are a separate product that supplements Original Medicare, and stand-alone Part D plans provide only prescription drug coverage — neither is a Medicare Advantage plan type. Each plan type imposes different provider rules: HMOs use networks and gatekeepers, PPOs allow out-of-network care at higher cost, PFFS plans let members see any provider who accepts the plan's terms, and SNPs tailor benefits to defined populations.

National insurance concept